New Hampshire Residential Rental Application

Application Date: [[Application Date]]

Property Applied For: [[Street Address]], [[City]], New Hampshire [[ZIP Code]]
Unit: [[Unit Number or "N/A"]]
Requested Monthly Rent: $[[Monthly Rent]]
Desired Move-In Date: [[Desired Move-In Date]]
Lease Term Requested: [[Month-to-Month / 12 Months / Other Term]]

Landlord / Property Manager:
[[Landlord or Management Company Name]]
[[Contact Phone]] | [[Contact Email]]
[[Mailing Address for Applications]], -

Important Disclosures Before Submitting Application

Under New Hampshire RSA 540-A:3:

• Prior to collecting any application or screening fee, the landlord must clearly disclose in writing the amount of the fee and that a satisfactory criminal background and/or credit check may be required.

• If the unit is not rented to the applicant, the landlord must return any amount collected beyond the actual documented cost of the background check, credit check, and reasonable administrative costs within thirty (30) days of receipt.

• Fees must reflect actual screening costs and may not be unreasonable or excessive.

This application is subject to the federal Fair Credit Reporting Act (FCRA). If an adverse action (denial, higher rent/deposit, or requirement of co-signer) is taken based in whole or in part on information in a consumer report, the applicant will receive an adverse action notice with the name, address, and telephone number of the consumer reporting agency and information about the right to obtain a free copy of the report and to dispute its accuracy.

All screening criteria are applied consistently and in compliance with the federal Fair Housing Act and New Hampshire RSA 540-A. Discrimination on the basis of race, color, religion, sex, national origin, familial status, disability, age, marital status, sexual orientation, gender identity, or other protected classes is prohibited., -

Section 1, Applicant Information (All adult occupants age 18+ must submit separate applications)

Section 2, Household and Occupancy

1. Proposed Occupants (names and ages of all who will reside, including children): [[List all proposed occupants]]

2. Will any pets reside at the property? [[No / Yes, describe type, number, age, weight: [[Pet Details]]]]

3. Vehicles to be parked: [[Number and types: [[Vehicle Details]]]]

4. Do you or any proposed occupant require a reasonable accommodation due to disability? [[No / Yes, describe without providing medical details: [[Accommodation Request]]]], -

Section 3, Employment and Income

Current Employer: [[Employer Name, Address, Phone]]

Position / Title: [[Job Title]]

Length of Employment: [[Years / Months]]

Supervisor / HR Contact: [[Name and Phone]]

Gross Monthly Income: $[[Gross Monthly Income]]

Other Income Sources (alimony, child support, disability, etc., optional but may be considered): [[Other Income Amount and Source or "None"]]

Previous Employer (if current < 1 year): [[Previous Employer and Dates]]

Co-Applicant / Additional Household Income (if separate application not filed): $[[Additional Monthly Income]]

Total Combined Gross Monthly Household Income: $[[Total Gross]], -

Section 4, Rental History (last 3 years preferred)

Current / Most Recent Landlord:
Name: [[Landlord Name]]
Phone: [[Landlord Phone]]
Address Rented: [[Address]]
Dates: [[From, To]]
Monthly Rent Paid: $[[Amount]]
Reason for Leaving: [[Reason]]

Prior Landlord:
Name: [[Landlord Name]]
Phone: [[Landlord Phone]]
Address Rented: [[Address]]
Dates: [[From, To]]
Monthly Rent Paid: $[[Amount]]
Reason for Leaving: [[Reason]]

Have you ever been evicted or asked to vacate? [[No / Yes, explain: [[Explanation]]]]

Have you ever been party to a lawsuit involving a landlord/tenant matter? [[No / Yes, explain]], -

Section 5, Credit, Criminal, and Background Authorization

I authorize the landlord or its agents to obtain consumer reports, credit reports, criminal background checks, eviction records, and employment/income verification from any consumer reporting agency, employer, landlord, or other source.

I understand that:

• A consumer report may be obtained for tenant screening purposes.

• If any adverse action is taken based on the report, I will receive written notice of the adverse action and the required FCRA disclosures.

• I have the right to obtain a copy of any report and to dispute inaccurate information directly with the reporting agency.

Applicant Signature authorizing checks: _______________________________ Date: [[Date]], -

Section 6, Application / Screening Fee Disclosure (RSA 540-A:3)

Application / Screening Fee Amount: $[[Fee Amount]]

Purpose: This fee covers the actual cost of obtaining a consumer credit report and/or criminal background check from a consumer reporting agency, plus reasonable administrative costs associated with processing the application.

Is the fee refundable? [[No, the fee is non-refundable to the extent it covers actual screening costs incurred. Any amount exceeding documented actual costs will be refunded within 30 days if the unit is not rented to the applicant. / Yes under the following conditions: [[Conditions]]]]

Fee must be paid by: [[Cash / Check / Money Order / Online Payment, made payable to [[Payee]]]]

I acknowledge that the fee amount and the requirement for satisfactory criminal background and credit check(s) were disclosed to me in writing before I paid the fee.

Applicant Initials: [[Initials]] Date: [[Date]], -

Section 7, Screening Criteria (Objective Standards Applied Uniformly)

The following minimum standards will be used to evaluate this application. All applicants are evaluated using the same criteria.

1. Income: Combined gross monthly household income must be at least [[Income Multiple, e.g. 2.5 or 3.0]] times the monthly rent. Verifiable income from employment, self-employment (2 years tax returns), Social Security, pensions, child support, or other lawful sources will be considered.

2. Credit: Minimum credit score of [[Minimum Score, e.g. 580 or 620]] from a major bureau, or acceptable alternative evidence of financial responsibility. Prior bankruptcies, collections, or judgments will be evaluated on a case-by-case basis considering time elapsed and circumstances.

3. Rental History: No evictions within the past [[X years]], no outstanding landlord judgments, and positive references from prior landlords regarding payment and conduct.

4. Criminal Background: Convictions for certain offenses (violent crimes, drug manufacturing/distribution on premises, sex offenses requiring registration) within [[Lookback Period]] may result in denial after an individualized assessment. Arrests not resulting in conviction will not be considered. Applicants will have opportunity to provide mitigating information.

5. Other: No more than [[Max Occupants]] persons per bedroom per applicable code; valid government-issued photo ID required; no false information on application., -

Section 8, Fair Housing and Nondiscrimination Notice

This property is offered in compliance with the federal Fair Housing Act, New Hampshire RSA 540-A, and the New Hampshire Law Against Discrimination (RSA 354-A). We do not discriminate on the basis of race, color, religion, sex, national origin, familial status, disability, age, sexual orientation, gender identity, marital status, or lawful source of income.

If you believe you have been discriminated against, you may contact the New Hampshire Commission for Human Rights or the U.S. Department of Housing and Urban Development., -

Section 9, Certifications and Signature

I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any false statement may result in denial of the application or termination of any tenancy.

I have read and understand the fee disclosure, screening criteria, and authorization above.

Applicant Signature: _______________________________ Date: [[Date]]

Printed Name: [[Full Legal Name]]

Co-Applicant Signature (if joint): _______________________________ Date: [[Date]]

Printed Name: [[Co-Applicant Name]], -

For Landlord Use Only

Date Received: _______ Fee Received: $______ Method: _______

Application Status: [[Approved / Denied / Pending Additional Info]]

If denied or adverse action taken, FCRA adverse action notice sent on: [[Date]] via [[Method]]

Notes: [[Landlord Notes]], -

*Sample template for New Hampshire, not legal advice. Application and screening fees are governed by RSA 540-A:3. All screening must comply with FCRA and fair housing laws. Adverse action notices are required when a consumer report is a factor in denial or other adverse decision. Verify current requirements and consult counsel for specific screening policies.*